Medicare and Dental Procedures
In the United States we are on the cusp of a major healthcare debate. Politicians have begun to advocate for “Medicare for All” as a very loosely interpreted form of single-payer insurance. Let’s take a look at what Medicare currently covers in terms of dental procedures for Part A and Part B subscribers.
Overall Medicare does not provide coverage for routine dental services. Medicare Part A will provide coverage for services done in a hospital setting that meet certain medical necessity criteria. A prime example is extractions done in anticipation of life-saving surgery or disease treatment. There would not however be coverage for replacement of the removed teeth.
Part B services provide similar coverage for services rendered outside an inpatient setting. These services must too contribute to an immediate need to render another medical procedure. Restoration of the affected area is typically not covered.
When patients have extensive dental needs they often times opt for supplemental plans that provide dental coverage. Or they will opt for Medicare replacement plans that provide more routine dental benefits than standard Medicare.
Providers should keep in mind that they must be enrolled with Medicare to submit claims on behalf of their patients. If providers are not enrolled it does not preclude the patient from seeking reimbursement. You can download the patient reimbursement form from the Centers for Medicare & Medicaid website and have your patient send it in with a copy of their itemized ledger from the date of service. Patients will need to followup on their claim with member services.